Methanol poisoning kills New Zealander and 28 others in Bali

A former Dunedin [New Zealand] man who died in Bali while on a rugby trip may have drunk a potent local cocktail that has been linked to 29 deaths.

Questions surround how a 29-year-old prominent Perth [Western Australia] rugby player on tour with his Nedlands Rugby Union Football Club, died in September 2011. The club's president, Hans Sauer, has been reported in The West Australian newspaper, as saying "maybe we're clutching at straws but he did drink one of those cocktails on the day he died. He was fit and always looked after his health."

The cocktails contain arak, made from fermented rice, palm sap, and other ingredients. If it contained methanol it could be fatal.

In 2009, 25 people died of alcohol poisoning after drinking arak containing methanol, a by-product of the incorrect distillation of ethanol.

In the same week the rugby player died, a New South Wales [Australia] nurse suffered suspected brain damage and kidney failure possibly related to a similar drink she had on the Indonesian island of Lombok.

His Dunedin family yesterday [30 Oct 2011] declined to comment on the claims, saying they were still waiting for professional and medical reports following his autopsy.

The club was holding an auction, including All Blacks and Wallabies jerseys, to raise funds for his family and had reportedly retired his number 10 jersey for next season to honour the premier grade player. [Byline: Rebecca Fox]===========================[Methanol is a clear, colorless liquid with a faint odor like alcohol, making it impossible to detect when mixed in alcohol.

Methanol toxicity remains a common problem in many parts of the developing world, where methanol is often a component of bootleg alcohol, which is made in rural regions. Because of its low cost, it is often consumed by those in lower socioeconomic classes, or is mistaken for desired alcohol. Methanol has a relatively low toxicity, hence the adverse effects are thought to result from the accumulation of formic acid, a metabolite of methanol metabolism. Formic acid metabolism is very slow, therefore it accumulates in the body, leading to metabolic acidosis.

Drinking methanol causes the same effects as excessive drinking, with the addition of pronounced vision problems. However, after the effects disappear, they reappear 6-30 hours later with much greater severity. The most seriously poisoned lose consciousness and die of respiratory or heart failure. Others may linger in a coma for as long as a week and may be left blinded.

Initial symptoms occur 12-24 hours after ingestion and in general correlate with the volume of methanol ingested and the amount of ethanol concomitantly ingested. The minimal lethal dose is believed to be 1 mg/kg body weight. Initial symptoms include disinhibition and ataxia followed by headache, nausea, and vomiting or epigastric pain. These are then followed by drowsiness, seizures, and eventually coma. Visual symptoms like flashes of light, blurring, scotomas, and scintillations occur and may progress to complete visual loss. Prompt medical care is vital to avoid complications secondary to methanol intoxication. Supportive therapy is aimed at initiating airway management, correcting electrolyte disturbances, and providing adequate hydration. The metabolic acidosis may necessitate administration of bicarbonate and assisted ventilation. Bicarbonate potentially may reverse visual deficits. In addition, bicarbonate may help to decrease the amount of active formic acid. The amounts may be thought of as less than a teaspoon of methanol can cause blindness and more than 4 teaspoons can be fatal.

Antidote therapy is directed towards delaying methanol metabolism until the methanol is eliminated from the system, either naturally or via dialysis, often accomplished in 2 ways: ethanol or fomepizole. Ethanol is also metabolized by alcohol dehydrogenase (ADH), and the enzyme has 10-20 times higher affinity for ethanol compared with methanol. Fomepizole is also metabolized by ADH; however, its use is limited because of high costs and lack of availability.